Testifying before the Senate Veterans’ Affairs Committee, Shinseki said an audit ordered last week of appointment systems at all VA facilities already has turned up scheduling “concerns” at some locations and the VA Inspector General’s office has been notified.

“Allegations of any adverse incidents like this makes me mad as hell. ... I am committed to taking all actions necessary to strengthen veterans’ trust in VA health care,” Shinseki said.

In a hearing that vacillated between deference to VA, which handled 83 million medical appointments last year, and criticism for its decade-long scheduling and accessibility problems, senators called for stronger leadership, dismissals of those involved and possibly criminal prosecution.

“With the numerous ... reports that have been released, VA senior leadership should have been aware that VA was facing a national scheduling crisis. VA’s leadership has either failed to connect the dots or failed to address this ongoing crisis,” said Sen. Richard Burr, R-N.C.

But Sen. Bernie Sanders, I-Vt., chairman of the veterans’ committee, cautioned against a rush to judgment. “When you are dealing with 200,000 people a day, even if you were doing better than every other health care institution in the world, you would have thousands of people saying they don’t like it,” Sanders said.

Shinseki promised action in the cases, which include allegations that 40 veterans died while waiting for appointments or referrals at the Phoenix Veterans Affairs Health System, when the facts are known.

He said he has no plans to shift management or fire personnel until then.

“I don’t want to get ahead of myself or ahead of the IG here. I want to see the results,” Shinseki said.

Both the House and Senate Veterans’ Affairs committees have held oversight hearings in the past decade on scheduling problems and access to care at VA medical centers, with whistleblowers and Government Accountability Office analysts testifying that some VA officers were gaming the system to meet department-wide goals.

But the problems reached crisis level last month when a retired physician from the Phoenix VA sent letters to CNN and the Arizona Republic alleging that the facility’s off-the-books wait list may have led to the deaths of at least 40 patients.

Similar reports have since surfaced in VA facilities in Texas, Wyoming, North Carolina and elsewhere.

Shinseki said the department’s response has not been stagnant. Since 2012, he said, VA has “involuntarily removed 6,000 employees,” although he acknowledged that not all were fired; some were moved to other jobs in VA while others were allowed to retire.

According to VA, results of the department-wide audit of appointment practices are expected in three weeks. At least one lawmaker, however, questioned the speed of that review, saying he understands from interviews with VA employees at a medical center that the review was “superficial.”

“It appears to me that this is more of damage control. It’s what people do when there’s allegations of mismanagement, improper conduct. You have another review,” said Sen. Jerry Moran, R-Kan.

After reports of alleged misconduct arose at the Phoenix VA, the VA’s inspector general staff asked for three hospital officials there to be put on administrative leave while they conducted their review.

The move was striking in a department that has not historically removed personnel from their jobs even under the most questionable circumstances, including the director of the Pittsburgh VA Health System, who received glowing evaluations during an outbreak of Legionnaires’ disease at her facility in 2011-12 that sickened 16 veterans and killed five.

Burr said he has been told that VA Undersecretary for Health Affairs Dr. Robert Petzel, in a recent phone call with regional VA chiefs, medical directors and the chief of staff, described the removal of the Phoenix chief as “political” and that she had “done nothing wrong.”

“Why should this committee, or any veteran in America, believe that change is going to happen as a result of what we’re going through?” Burr asked.

Throughout the hearing, criticism of Shinseki came from both sides of the political aisle, with Sen. Richard Blumenthal, D-Conn., raising what he called the “elephant in the room,” criminal conduct.

He said he believes the evidence is sufficient to call in criminal investigators such as the FBI, even though the IG’s report is not complete.

“It’s your responsibility ... without rushing to judgment, without reaching any conclusions, to involve appropriate federal criminal investigative agencies, if there is sufficient evidence of criminality,” Blumenthal, the former Connecticut attorney general, told Shinseki.

Shinseki, a 38-year combat veteran who lost part of his foot in Vietnam, is the longest serving secretary in VA history and the longest serving leader of federal veterans programs since the end of the Vietnam War.

During the hearing, he called his service as secretary a privilege, noting that he is able to “care for people I went to war with many years ago, and people I have sent to war, and people who raised me in the profession when I was a youngster.”

Some veterans groups, including the American Legion and Concerned Veterans For America, have called for his resignation. Others, however, such as the Veterans of Foreign Wars and Disabled American Veterans, have stood behind him.

The results of the IG investigation into the Phoenix Veterans Affairs Health System are not expected until August.